Turning the Spotlight on Stigma: The Next Frontier in Global Abortion Access

A study published earlier this year by the Guttmacher Institute provides a rare and up-to-date, if murky, picture of abortion worldwide. Globally, abortion rates have stagnated, yet a greater proportion of them are unsafe and most of them occur in the developing world.

It’s not great news.

While the world’s abortion laws can be carefully tracked and some have been liberalized, data about how many abortions take place, where, and why, are based on educated guesses, in part because of poor reporting systems. All of this has meant that there has not been as much progress on reducing unsafe abortion worldwide as we might have hoped. Continued lack of access to contraception is a huge factor in this, but there is another shadowy figure in the picture: Stigma.

Laws and policies create the framework of abortion access, but abortion stigma is the squishy social filler that has as much, if not more, power to prevent or compel an individual with regards to access to safe services. Abortion stigma worldwide has remained largely undocumented and unaddressed for years. That is changing. A handful of women’s rights and research groups are embarking on what is conceivably the next frontier of global safe abortion efforts – tracking, documenting and studying abortion stigma around the world.

This work entails close measurement of stigma’s manifestation at multiple levels: individual, community, facility, legal, and institutional. Notoriously difficult to define, abortion stigma largely stems from society’s attitudes toward women’s sexuality, and beliefs about what constitutes a “good” woman, mother, and wife. If you terminate a pregnancy, you aren’t what we think women should be: kind, motherly, conceding. The choice is often viewed as flippant, selfish, and unfeminine. It can function to prevent a woman from seeking care, or punish her for doing so.

The hope is that by pinning it down and dissecting it – looking at why and how abortion is stigmatized – we can blow the cover off of it, eventually etching away at its influence.

“Even if we don’t get rid of stigma all together, which we definitely won’t, we need to give women the space to have their own positive strength and motivation, and a resilience to stigma from others,” says Kelley Culwell, formerly Senior Advisor on Abortion for the International Planned Parenthood Federation (IPPF).

Last summer, IPPF convened a closed-door meeting with representatives from more than 20 health and rights groups around the world, to share current and planned work on abortion stigma. “I was surprised at the amount of interest in this issue – so many organizations wanted to be a part of it and some groups were doing some work that we had no idea of,” said Culwell, who helped organize the meeting. One month later, IPPF launched a three-year project that will focus on addressing abortion stigma in a number of reproductive health facilities around the world.

IPPF’s work at the facility level dovetails with the work of the rights group Ipas, who, for the past five years, has been documenting stigma at the community level. They are in the process of developing a “stigma scale” and a set of indicators that will allow them to track community attitudes in a systematic way, and are undertaking research in Ghana, Zambia, India, and Mexico. A study published last year showed that attitudes around abortion were startlingly similar in five countries around the world, almost regardless of the country’s abortion law.

Because abortion stigma is such a slippery concept, recent efforts are to study it in the most rigorous way possible.

We need more formative, empirical research to understand the roots, causes, manifestations, and consequences for women, providers, pharmacists. We need to better understand how stigma plays out,” says Leila Hessini, Director of Community Engagement and Mobilization at Ipas.

Ipas and others will undertake trends analysis and are pushing to public academic studies, steadily building up the body of research that other advocates and researchers can work from.

Bringing stigma into the light could have very practical and crucial applications for women worldwide. First, it enables providers, advocates, and policymakers to dole out better care to women – designing policies and programs that better take into account the personal and social pressures they deal with. Second, reducing stigma could have policy impact. While findings show that stigma exists regardless of how restrictive abortion laws are, it in turn serves as an incubator for restrictive policies. “The stigma around abortion is what keeps governments in those countries from really aggressively trying to decrease unsafe abortion,” says Culwell.

Yet perhaps the most essential fact that has been uncovered about abortion stigma so far is the role that we all play in it.

“Sigma is like a weather system that we’re all a part of. We may be resistant to that system, thinking ‘I’m not going to accept the idea that a woman who has an abortion is wrong,’ but we’re not really changing it,” says Kate Cockrill, who directs research at the Advancing New Standards in Reproductive Health (ANSIRH) program at University of California, San Francisco.

ANSIRH is studying the individual experiences of stigma among women in the United States who have had abortions. So how do we study a weather system, which our very presences influences? Moreover, how do we change it? That is all part of the new frontier.

“It’s a very exciting time,” says Hessini. “It is great to see this energy and mobilization around stigma, more people engaged in research. It’s a frontier that we all need to focus on and address.”

While there are many avenues still to explore, the excavation already underway will almost certainly transform the issue of abortion worldwide in the coming decades.